Fussy Eater? Or Could It Be Something More…?

Fussy Eater? Or Could It Be Something More…?

I’m sure most parents have gone through a fussy eating stage with their toddlers…I certainly have. However, for some individuals, what may seem at first to be fussy eating can persist or get worse until it is having a profound effect on the child’s and the family’s lives.

Research shows that 25-30% of typically developing individuals have a feeding difficulty, which can rise to anything between 33-80% in individuals who have a developmental delay.

Common feeding issues can include:

  • Restricted Eating Patterns
  • Refusal to Participate in Mealtime Routines
  • Over/Under Consumption of Food or Fluids

Addressing feeding issues is important to improve:

  • The individual’s health and wellbeing
  • The individual’s inclusion in social routines
  • The wellbeing of the family

When deciding on which form of intervention is most appropriate, we need to first and foremost ensure that we have assessed every factor that may be contributing towards the feeding issue. The factors that may affect feeding are:

  • Medical
  • Sensory
  • Oral Motor
  • Behavioural


Initially we need to ensure that there are no underlying medical issues affecting the individual’s feeding, such as reflux or constipation. If there are any existing medical issues, then it is advised that this is under control before any feeding therapy commences. This is to ensure that the individual is not experiencing any pain whilst feeding.

It is also advised that if there are any issues surrounding the individual’s ability to swallow safely, then this will need to be assessed by a Dysphagia trained Speech and Language Therapist prior to feeding therapy.


An individual’s feeding difficulties may be sensory based. If there are concerns regarding the sensory issues around feeding, then an assessment can be carried out to conclude which sensations an individual can or cannot tolerate. Liaison with an Occupational Therapist may also be required to discuss the individual’s sensory system.

Oral Motor

When assessing oral motor skills, we need to determine whether the individual has the following skills required for feeding:

  • Chewing – Is the individual able to chew their food? Or they sucking the food, or mashing it with their tongue? If they can’t chew then they are running the risk of swallowing the food whole. Many parents report that feeding difficulties started around 18months, which so happens to coincide with when we start feeding children foods which require more chewing
  • Cheek Strength – If there is reduced cheek strength then the individuals could end up having food stuck between their gums and their cheeks
  • Lip Closure – If they are unable to close their lips, then food will spill out of their mouth, or they may not be able to close their lips around a spoon.
  • Tongue Movement – We require sufficient tongue movement for feeding which includes:
    • Retraction – to aid an effective swallow
    • Lateralisation to move food from the front of the mouth to the back molars for chewing and to keep the food in place whilst we chew


The main consequences for the refusal of food are:

  • Access to a preferred food
  • Avoidance of the less preferred food

Research suggests that avoidance of the less preferred food is a part of the reason for 90% of individuals with a feeding difficulty.

Behavioural interventions can be implemented to increase acceptance of new foods and decrease behaviours which challenge.

Feeding issues are likely to be a mixture of all these factors, therefore careful consideration is required when deciding which programme of intervention will be most appropriate and successful for each individual.

Skybound have been successful in gaining funding for our feeding interventions from various bodies, including charities and NHS clinical commissioning groups.

To find out more about our SLT services click here 

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